Hyaluronic acid (HA) is a powerful humectant and key component of the body's connective tissues, but its interactions with other substances are not one-size-fits-all. The form of hyaluronic acid you use—injected into joints or as a dermal filler, taken as an oral supplement, or applied topically—determines the necessary precautions and potential risks. For injectable forms, the biggest concern is managing the risk of bleeding and bruising, which is heightened by certain medications and supplements.
Injectable hyaluronic acid: Important precautions
Injectable hyaluronic acid, used for dermal fillers and joint injections, requires careful consideration of other substances to minimize adverse effects. The trauma of the injection process itself can interact with other drugs and supplements to cause complications.
Avoid before injections to reduce bleeding and bruising
Prior to receiving injectable HA, such as fillers or joint injections, healthcare providers will often advise patients to temporarily stop taking specific medications and supplements that thin the blood. This helps prevent or minimize potential bleeding and bruising at the injection site.
Commonly avoided medications and supplements include:
- Blood Thinners: Patients on chronic anticoagulants like warfarin, Eliquis, or others must consult their prescribing doctor before any procedure. The risk of discontinuing anticoagulation therapy usually outweighs the risk of injection, so bridging or monitoring may be necessary.
- NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil), and naproxen (Aleve) should be stopped, typically one week before the procedure.
- Certain Supplements: A wide range of supplements can increase bleeding risk and should be avoided in the week leading up to the procedure. These include:
- Fish oil
- Vitamin E
- Ginkgo biloba
- St. John's wort
- Garlic
- Ginger
- Turmeric
- Alcohol: Consumption of alcohol in the 48 hours leading up to an appointment can increase bruising.
Other contraindications and considerations for injections
- Allergies: Known hypersensitivity to hyaluronic acid or components of the formulation, such as proteins from gram-positive bacteria used in manufacturing or lidocaine mixed in the syringe, is a contraindication.
- Infections: Injections should not be administered at or near sites with active infections or skin diseases to prevent complications.
- Herpes Simplex: For injections around the mouth, patients with a history of cold sores may need to take a prophylactic oral antiviral medication, as the injection can trigger a flare-up.
Oral and topical hyaluronic acid: Interactions and precautions
Compared to injectable forms, oral and topical hyaluronic acid have very few reported drug-drug interactions and are considered largely safe for most users. However, there are still a few important considerations.
Oral HA supplements
- Cancer History: High-molecular-weight HA is normally anti-inflammatory and immunosuppressive. However, low-molecular-weight HA can have pro-inflammatory and cell-proliferative effects. This has led to conflicting information regarding oral HA and cancer. Some sources suggest oral HA should be avoided by those with a history of cancer due to potential cell proliferation effects, while other studies show benefits, such as reducing mucositis during chemotherapy. This is an evolving area of research, and medical guidance is crucial.
- Pregnancy and Breast-feeding: The safety of oral HA for pregnant or breast-feeding individuals is not established due to a lack of reliable information. Avoidance is recommended.
Topical HA products
- Radiation Therapy: Applying topical HA to the skin while undergoing radiation therapy may increase the risk of skin complications.
- Scleroderma: For individuals with scleroderma, topical HA might worsen skin ulcers.
- Topical vs. Fillers: It is generally safe to use topical HA with dermal fillers, as it can help maintain hydrated skin. However, always consult with your provider on timing and product choices to avoid irritation.
Comparison of HA Forms and Key Interactions
This table summarizes the main interaction considerations for each type of hyaluronic acid use.
| Feature | Topical Hyaluronic Acid | Oral Hyaluronic Acid | Injectable Hyaluronic Acid (Fillers & Joints) |
|---|---|---|---|
| Drug Interactions | None reported. Avoid with radiation therapy or scleroderma. | None commonly reported with most drugs. | Potential complications with blood thinners and NSAIDs due to bleeding/bruising risk. |
| Supplements to Avoid | None. | None commonly reported. Caution suggested for those with cancer history due to some conflicting evidence. | Vitamin E, fish oils, garlic, ginkgo, and other supplements that increase bleeding risk should be stopped prior to injection. |
| Medical Conditions | Avoid with scleroderma or during radiation therapy. | History of cancer warrants a doctor's consultation due to conflicting data on its effects on tumor cells. | Absolute contraindications include active infection at the injection site or bleeding disorders. Consider pre-medication for those with a history of herpes simplex for facial injections. |
| Allergy Concerns | Rare, but possible. | Rare, but possible. | Hypersensitivity to HA, bacterial proteins, or local anesthetics is a contraindication. |
Conclusion
The question "What can I not take with hyaluronic acid?" has different answers depending on the method of administration. For topical and oral use, there are very few established drug interactions for the general population. However, anyone with a history of cancer, scleroderma, or undergoing radiation therapy should consult a doctor before using HA. For injectable HA, the list of precautions is much more extensive. Patients must temporarily stop using blood-thinning medications and supplements before a procedure to minimize bleeding and bruising risks. Always disclose your full medical history, including all medications and supplements, to a qualified healthcare provider before any cosmetic or medical injection involving hyaluronic acid.
For more detailed information on specific medical contraindications, always consult a healthcare professional. Reliable resources can be found through organizations like the National Institutes of Health.
